Command Operations 203s

Question 1

A “multi-patient incident” is defined as any incident with fewer than __ patients.

Answer 1

25.
The first-arriving company officer at the scene of a multi-patient, or mass casualty or disaster incident shall establish Command. The initial Incident Commander (IC) shall remain in Command until Command is transferred or the incident is stabilized and Command is terminated. Command is responsible for the completion of the tactical objectives. The General Tactical objectives, listed in order of priority, are:
1. Remove endangered occupants and treat the injured.
2. Stabilize the incident and provide for life safety.
3. Ensure the functions of triage, extrication, treatment and transportation are established.
4. Provide for the safety, accountability and welfare of rescue members and victims.
5. Conserve property.
203.01
2/10

Question 2

A “mass casualty incident” is defined as any incident involving __ to __ patients.

Answer 2

25-100.
The first-arriving company officer at the scene of a multi-patient, r mass casualty or disaster incident shall establish Command. The initial Incident Commander (IC) shall remain in Command until Command is transferred or the incident is stabilized and Command is terminated. Command is responsible for the completion of the tactical objectives. The General Tactical objectives, listed in order of priority, are:
1. Remove endangered occupants and treat the injured.
2. Stabilize the incident and provide for life safety.
3. Ensure the functions of triage, extrication, treatment and transportation are established.
4. Provide for the safety, accountability and welfare of rescue members and victims.
5. Conserve property.
203.01
2/10

Question 3

A “disaster” is defined as any incident involving more than ___ patients.

Answer 3

100.
The first-arriving company officer at the scene of a multi-patient, r mass casualty or disaster incident shall establish Command. The initial Incident Commander (IC) shall remain in Command until Command is transferred or the incident is stabilized and Command is terminated. Command is responsible for the completion of the tactical objectives. The General Tactical objectives, listed in order of priority, are:
1. Remove endangered occupants and treat the injured.
2. Stabilize the incident and provide for life safety.
3. Ensure the functions of triage, extrication, treatment and transportation are established.
4. Provide for the safety, accountability and welfare of rescue members and victims.
5. Conserve property.
203.01
2/10

Question 4

The EMS Tactical objectives to be completed during any multi- patient/mass casualty, disaster incident are?

Answer 4

1. Completion of a”TriageReport”
2. Declaration of”All Immediates Transported”
3. 01

Question 5

Basic Operational Approach for Major Motor Vehicle Accidents(2N1):(read only)

Answer 5

1. Give an on-scene report and assume command.
2. Initiate triage.
3. Perform a rapid hazard assessment and establish a safe zone to operate.
4. Initiate traffic control and provide a safe work treatment area.
5. Provide for hazard protection(charged handline,etc.).
6. Call for additional resources.
7. Radio a Triage Report to Alarm.
8. Stabilize hazards and/or remove patients to a treatment area.
9. Assign crew(s) specific task(s) to accomplish through early sectorization (triage, extrication, treatment, and transportation) or by geographic location (north, south, east, west).
   10.Initiate patient assessment and treatment functions.
   11.Coordinate patient transportation.
   203.01
   3/10

Question 6

Responding members are encouraged to use triage tags and IMMEDIATE labels on:

Answer 6

Smaller multi-patient incidents.
Triage tags should be used any time there are three (3) or more IMMEDIATE patients or more than ten (10) patients.
In the multi-patient incident scenario, most often a multiple vehicle collision, use of the triage system can greatly improve initial scene organization, and enhance its use during mass casualty incidents.
203.01
4/10

Question 7

MINOR patients who were directed earlier in the incident by triage teams to an Assembly Area will be assessed by?

Answer 7

Extrication and delivered to the treatment area if further medical care is warranted.
203.01

Question 8

NOTES FOR MULTI-PATIENT INCIDENTS(1-25):(read only)

Answer 8

1. Patient triage should be performed by the first arriving company.
   Normally, it will last less than 4-6 minutes. A sector assignment may not be necessary.
2. Extrication may be assigned, if needed, when physical disentanglement or patient removal to a treatment area is needed.
3. Treatment is preferred in a designated treatment area, or can be performed “in-place,” as directed by Command.
4. The Transportation Sector function maybe managed by Command or assigned to a designated member, depending on complexity of the incident.
5. A Level II Staging area should be used for the balance of the assignment (after the Level 1 approach). All resources must stage.
6. Transportation Sector will need a minimum of one company assigned to perform its functions, and may be assigned a separate tactical channel.
7. A minimum of one company should be assigned to the LZ, with the Company Officer becoming “LZ Sector.”
   203.01
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Question 9

NOTES FOR MASS-CASUALTY INCIDENTS(25-100):(read only)

Answer 9

1. Triage should continue as a Sector and may involve several companies.
2. The treatment area must be identified early and include patient re-evaluation.
3. Medical Branch and Transportation Branch should be considered with a large number of patients.
4. Transportation Branch has a Loading Coordinator assigned to the treatment area.
5. Transportation Branch will need a minimum of one company assigned and should operate on a separate tactical radio channel.
6. A minimum of one engine should be assigned to the LZ, with the Company Officer assigned as “LZ Sector.”
7. The Hospital Communication Coordinator should check and re-check hospital availability through Alarm.
8. Rescues/Ambulances should be sent to the loading area, no more than two at a time.
9. Phoenix’s Medical Support 19 can be dispatched to the scene through Alarm.
   203.01
   9/10

Question 10

NOTES FOR DISASTER INCIDENTS(over 100):(read only)

Answer 10

1. Medical Supply and the Morgue are handled by Logistics.
2. Transportation Branch should have a Transportation Sector assigned to each treatment area.
3. Due to the large number of helicopters, air operations will be established to coordinate aero-medical and other aircraft.
4. Each medical branch should have a geographic identity(i.e.,”West Medical Branch”).
5. Consider a separate radio channel for each Branch. Command will need at least one officer to monitor each channel at the Command Post.
6. Each Branch Director will need adequate support staff to manage their assigned activities and resources.
7. The Branch Director should be located at the assigned activity area/impact site.
   203.01
   10/10

Question 11

The following items represent the standard operations that will normally be performed by the Extrication Sector:(Read only)

Answer 11

1. Determine the location, number and condition of all patients (coordinate with Triage).
2. Determine if triage will be performed in place or at the entrance to the treatment area (see “Triage Sector”).
3. Determine resources.
4. Assign and supervise extrication teams.
5. Extricate and deliver patients to the treatment area(s)or to a casualty collection point.
6. Provide frequent progress reports to Command.
7. Ensure safety and accountability of all patients and assigned members.
8. Coordinate activities with other Sectors.
9. Notify Command when all patients have been removed and that companies are available for reassignment, “All clear in Extrication Sector”.

An Extrication Sector is utilized in multiple patient incidents that require physical disentanglement and/or the removal of trapped victims.
The Extrication Sector is responsible for removing and delivering patients to a treatment area. The Extrication Sector will provide any patient treatment that is necessary prior to disentanglement.
203.03
2/4

Question 12

To reduce confusion and congestion, Triage will initially direct all MINOR (ambulatory) patients using the S.T.A.R.T. criteria to a specific area. ________ Sector is later responsible to further assess these patients once more critical activities have taken place.

Answer 12

Extrication.
203.03
4/4

Question 13

A Treatment Sector is utilized to provide?

Answer 13

A site to manage the treatment of multiple IMMEDIATE and DELAYED patients.
Treatment Sector is responsible for establishing a treatment area to provide stabilization and continuing care of patients until they can be transported to a medical facility. The objective of the treatment sector is to rapidly treat and transport all patients.
203.04
2/5

Question 14

The treatment entry point should be readily identified:

Answer 14

Traffic cones and have members to direct arriving patients.

203.04

Question 15

When new unaccounted patients arrive at treatment sector and they get triaged. What should the Treatment sector officer do?

Answer 15

Forward a “triage update” to Command.
During major incidents, one company per four (4) patients should be the initial objective (one Rescue/ambulance per patient). As resources permit, the overall goal is to provide all the resources necessary to treat all the patients.
203.04
3/5

Question 16

Who must cause aggressive treatment and packaging of patients with an emphasis on rapid transport?

Answer 16

The Treatment sector officer.

203.04

Question 17

Transportation BRANCH has the following responsibilities:(Read only)

Answer 17

-Ensure the functions of transportation are carried out.
-Supervise and coordinate the transportation functions and member assigned.
-Determine/request resource needs to Command.
-Communicate direction to tactical units (sectors).
-Ensure units are completing objectives.
-Maintain incident documentation.
203.05A
2/3

Question 18

The following represents the standard operations that will be performed by the Transportation BRANCH:(read only)

Answer 18

1. Coordinate the assignment of ambulances from Staging area to various sectors (e.g., East Transportation, West transportation, LZ).
2. Determine hospital availability status through Alarm.
3. Coordinate all patient allocation and hospital destination.
4. Coordinate the movement of patients from treatment areas to ambulance loading areas or helicopter landing zone.
5. Maintain an accounting of all patients and patient destinations.
6. Ensure the safety and accountability of all assigned members.
7. Provide frequent progress reports to Command.
8. Notify Command when all IMMEDIATE patients have been transported.
   203.05A
   2/3

Question 19

Where should the Transportation branch director be located?

Answer 19

At a central location, preferably at or close to the Command Post.
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2/3

Question 20

The following represent the standards operations that will be performed by the Transportation Sector Officer:(read only)

Answer 20

-Determine/request resources.
-Determine (with Command) the Rescue/ambulance loading area and helicopter landing zone, as needed.
-Determine hospital availability status by contacting Alarm.
-Coordinate patient allocation and destination with Treatment Sector.
-Aggressively supervise the movement of patients from the treatment area to the ambulance loading area or helicopter landing zone.
-Maintain an accounting of all patients and patient destinations.
-Provide progress reports, allocations, ETA’s, to receiving hospitals.
-Ensure the safety and accountability of all assigned members.
-Provide frequent progress reports to Command.
-Coordinate activities with other sectors, especially Treatment.
-Notify Command when all IMMEDIATE patients have been transported.
203.05
2/4

Question 21

Who is responsible for allocating patients to medical facilities according to patient injury and priority, hospital capacity and specialty? (pediatric, burns, Immediate injuries, etc.).

Answer 21

The transportation sector officer.

203.05

Question 22

Which Sectors must maintain close coordination to determine the most appropriate allocation for each patient during large events?

Answer 22

Treatment and Transportation sectors.

203.05

Question 23

Any incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties is known as what?

Answer 23

Mass/Multi Casualty Incident(MCI).
203.06
2/6

Question 24

Integrated active shooter response should include the critical actions contained in the acronym THREAT. Which stands for what?

Answer 24

-Threat suppression
-Hemorrhage control
-Rapid
-Extrication to safety
-Assessment by medical providers
-Transport to definitive care
203.06
3/7

Question 25

Alarm level rule of thumb:

5-10 Patients (Based on 1/3 of Patients are Immediates)

Answer 25

First Alarm Medical Total Resources 
-Four ALS Engines 
-Two Extrication units 
-Four Transports
-Battalion 
-East Deputy 
-Connectors 
-Command Van 
-Utility 
-Rehab
203.06
3/7

Question 26

Alarm level rule of thumb:

11-20 Patients (Based on 1/3 of Patients are Immediates)

Answer 26

Two Alarm Medical Total Resources 
-Eight ALS Engines 
-Four Extrication units 
-Six Transports
-Three Battalions 
-East Deputy 
-Transport Supervisor 
-Medical Supply
203.06
3/6

Question 27

Alarm level rule of thumb:

21-100 Patients (Based on 1/3 of Patients are Immediates)

Answer 27

Two Alarm Medical, Upgraded to four Alarm Medical
-Eight ALS Engines 
-Four Extrication units 
-Six Transports 
-Three Battalions 
-East Deputy 
-Transport Supervisor 
-Medical Supply 
-MMRS
-Balance of a fourth Alarm Medical 
-Twelve Closest ALS Engines Ladders (LT, Squads) 
-Four Transports 
-Four Battalions 
-South Deputy/District 
-Rehab 
-Utility
-Consider EOC Activation
203.06
4/6

Question 28

Disaster between 100-1000 patients plus are considered disaster response events. Resources for this type event will include:

Answer 28

-Metropolitan Medical Response System (MMRS)
-EOC Activation
-State HazMat Response
-DMAT
-National Guard
-DPS may be notified.
-Notification of Hospitals if HazMat (Contamination concern)
203.06
5/6

Question 29

During an active shooter/tactical event. If the number of victims is unknown then upgrade to?

Answer 29

Initiate a MCI Alarm level 1 until a count can be determined.
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5/6

Question 30

During large-scale or complex MCIs (e.g., a fire with multiple victims/tactical environment incident), designate a ___ ____ to reduce the span of control.

Answer 30

Medical branch.

203.06

Question 31

Medical Branch Responsibilities during a MCI:(read only)

Answer 31

1. Radio designation “Medical.” (Refer to SOP201.01)
2. Assure Triage, Treatment, and Transport has been established. If established by Command, Triage, Treatment, and Transport will now report to the Medical Branch.
3. Work with Command, and direct and/or supervise on-scene personnel from agencies such as the Medical Examiner’s Office, Red Cross, private ambulance companies, and hospital volunteers.
4. Ensure notification of MedicalControl..
5. If the incident is due to a known or suspected WMD, Ensure patients have been through decontamination, than assist with antidotes, and treatment of victims.
6. Ensure proper security of incident site, treatment area, and loading area; also provide for traffic control and access for emergency vehicles, including law enforcement.
   203.06
   5/6

Question 32

The Medical Support unit will be dispatched on all ____ Alarms and greater incidents.

Answer 32

Second.

203.06

Question 33

Any event or occurrence where an armed person, who has used deadly physical force on other persons and continues to do so while having unrestricted access to additional victims.

Answer 33

Active shooter/Hostile event.(ASHE)
203.06A
3/13

Question 34

An armed person who has used deadly physical force on other persons and continues to do so while having unrestricted access to additional victims and ammunition.

Answer 34

Activer shooter.
203.06A
3/13

Question 35

A static situation involving an armed suspect, (with or without hostages), who has demonstrated or voiced violence, and has fortified a position of advantage in a room or building. No indication of immediate harm to any hostages.

Answer 35

Barricaded/hostage incident.
203.06A
3/13

Question 36

A specific, designated area located within the incident where patients are gathered, and determination is made for transfer, extrication or further needs.

Answer 36

Casualty collection point.(CCP)
203.06A
3/13

Question 37

Protects you from observation, such as trees or bush, will not protect from weapon fire.

Answer 37

Concealment.

203.06a

Question 38

Protects you from observation and weapon fire.

Answer 38

Cover.

203.06a

Question 39

A group of Law Enforcement Officers that have the intent to stop the suspect(s) deadly actions

Answer 39

Contact team.

203.06a

Question 40

An incident that is fluid, evolving and changing with constant movement, multiple casualties, and other tactical challenges.

Answer 40

Dynamic situation.
203.06A
3/13

Question 41

A group of personnel responsible for the rapid relocation or extrication of viable casualties to a Casualty Collection Point or cold zone (Triage or Treatment area) for triage, treatment and transport.

Answer 41

Extrication teams.
Extrication teams operate in the cold zone, often receiving casualties from Rescue Task Force Teams at the threshold of the warm zone.
203.06A
3/13

Question 42

The shooter(s) are dead, in custody, fled the scene, reasonably contained or barricaded.

Answer 42

Neutralized or contained.
203.06A
4/13

Question 43

Responding PD unit will be Identify as:

Answer 43

-Paul=Patrol
-David=Detective
-Sam=Sargent
-Lincoln=Lieutenant
Responding PD units will be identified as Paul, David, Sam and Lincoln. The name is typically accompanied by a number (i.e. Sam 27).
203.06A
4/13

Question 44

Any event or occurrence where the reporting party states that a person does or did have a gun. This would include any handguns or long guns.

Answer 44

Person with a gun incident.
203.06A
4/13

Question 45

A set of teams deployed to provide point-of-wound care to victims where there is an on-going ballistic or explosive threat. These teams treat, stabilize, and remove the injured in a rapid manner while under the dedicated protection of law enforcement officers.

Answer 45

Rescue Task Force.(RTF)
RTF teams operate primarily in warm zones. They do not operate in hot zones.
203.06A
4/13

Question 46

An explanation in which response personnel operate under that ensures the visibility, assessment and mitigation of risk and loss of life in an emergency situation.

Answer 46

Risk management profile.
*We may Risk our lives a lot to protect savable lives
*We may Risk our lives a little to protect savable property
*We will not Risk our lives at all to save what is already lost
*All of the above are under a structured and calculated plan
203.06A
4/13

Question 47

Ballistic protection:(Read only)

Answer 47

• Ballistic vests and helmets shall be worn while operating at an Active Shooter/Hostile Event.
• Company Officers, based on their experience and dispatch information, have the discretion for their crews to don ballistic PPE on additional events. If a Company Officer chooses to have their crews don ballistic PPE, they should ensure a BC is part of the assignment.
203.06A
12/13

Question 48

Direct and immediate threat exists. The area is within range of direct gunfire or explosive devices. Areas unsecured or unsearched where a suspect could be hiding. Considered an (IDLH) environment where only law enforcement resources can operate.

Answer 48

(ASHE) Hot zone.
203.06A
5/13

Question 49

Rapid point of wound stabilization at or near the point of wounding and rapid extrication to definitive care.

Answer 49

Tactical Emergency Critical Care.
203.06A
5/13

Question 50

Specific items have been identified for consideration in this guideline as part of the progression in dealing with an active shooter/hostile incident. These considerations are important for the initial Incident Commander to consider in the development of an incident action plan.(Read only)

Answer 50

Critical Tactical Considerations.
Items listed below are considered critical benchmarks and shall be completed prior to entry of fire department personnel into warm zones as part of a joint PD/FD rescue teams. The Critical Tactical Considerations are defined as:
Unified Command Established
- Initial Police and Fire Unified command shall be in place with good communications and jointly located. This needs to be in place as soon as possible. Initial Police and Fire Unified command must agree that there are viable casualties. Initial Police and Fire Unified command must consider the Risk Management Profile and available information and jointly develop or at a minimum jointly approve a rescue plan. The Fire IC will consider the Risk Management Profile and all information available and has the final say as to deployment of fire resources into the warm zone. Accountability shall be in place and tracked throughout the incident. Rescue Task Force members shall be in constant communication with Fire IC or designee.
Ingress and Egress Established
- Initial Police and Fire Unified command shall designate and agree to a specific ingress and egress path for Rescue Task Force teams.
Casualty Collection Point Established
- Designate a location for the Casualty Collection Point (CCP).
Warm Zone Established
-·The boundaries of the specific warm zone area for entry shall be defined and communicated to the Extrication team(s) and RTF team(s) to ensure personnel do not enter hot zones
203.06A
12/13

Question 51

Coordinates ambulance/rescue usage with Treatment Sector and also, notifies and coordinates the number of patients sent to hospitals.

Answer 51

Transportation sector.
203.06A
5/13

Question 52

Set in the “Cold Zone” and allocates resources to treat casualties with an emphasis on rapid treatment and transportation.

Answer 52

Treatment sector.
203.06A
5/13

Question 53

Any event or occurrence in which personnel may be exposed to harm as a result of a violent or threatening act whether real or implied.

Answer 53

Violent incident.
203.06A
5/13

Question 54

The area where a potential threat exists, but the threat is not direct or immediate. An example is an area of an incident that the Law Enforcement Contact Team has been through without engaging the subject(s) and communicated the location of viable victims. Threat may exist elsewhere in building/venue, but law enforcement has cleared and secured an area for fire and EMS to extract viable patients.

Answer 54

(ASHE)Warm zone.
203.06A
5/13

Question 55

It is the responsibility of the first Command Officer(ASHE) to contact MPD Command and accomplish the _____ __ __________.

Answer 55

Functions of Command.
Initial Actions (Extrication/Rescue Task Force Teams)
Command will identify crews for Extrication teams and for Rescue Task Force teams. Extrication teams will be made of Fire Department members and may or may not have PD protection. The purpose of Extrication teams is to move patients to a secure Treatment area or Casualty Collection Point. Rescue Task Force teams will be made up of PD security members (force protection), and FD members and assigned to address an appropriate size search and retrieval area. Multiple Rescue Task Force teams may be required. The purpose of Rescue Task Force is to operate in ‘clear, not secured’ warm zone areas under the direct protection of PD Force Protection providing rapid triage and relocation of viable patients.
203.06A
9/13

Question 56

Mesa Dispatch and MFMD Units should share updates during (active shooter) response which may include:(read only)

Answer 56

• Type of violence, terrorism, stabbing, shooting-handgun, rifle, etc.
• Status of weapons and suspects
• Number of known casualties
• Location of law enforcement officers, incident commander or command
post
• Ideal direction of approach or best scene access
• What type of environment you are responding to: Residence, School,
Public area, Commercial building, etc.
Crews should monitor their 800 MHz radio designated PD channels for additional information.
203.06A
7/13

Question 57

When units are directed to stage(active shooter) or make the decision to stage they shall:(read only)

Answer 57

• Stage out of sight of the incident and away from crowds if possible and the movement path of crowds.
• Assume Fire Incident Command
• Provide continuous scene size-up for dangerous activity or opportunities to move forward based on new information.
• Utilize 800 MHz radio to communicate on designated PD channels for additional information.
• Stage out of any potential line of fire and behind cover.
• Have an egress plan without backing up.
• Turn off warning lights while staged.
• Notify PD that they are staged and location. (i.e. BC1 and E2 staged west)
• When a Command Officer arrives, they will contact PD on their tactical channel to identify the location of PD command post.
• Contact Dispatch for additional information, if applicable.
203.06A
8/13

Question 58

Units called into a secured scene(active shooter) or moving forward from staging into a secured scene shall:(read only)

Answer 58

• Contact Fire Command or MPD by radio for additional information, if applicable.
• Identify PD command location. (i.e. “Battalion 1 copies PD supervisor is located to the west near the theaters)
• Proceed with caution while conducting a windshield survey.
• Continue to monitor designated PD channels for additional information.
• Turn off warning lights when approaching the scene if practical.
• Don complete ballistic PPE needed EMS PPE.
• Be aware that bystanders and/or crowd may be a hazard or stop you from completing assignment.
• Have someone specifically assigned to always be a lookout. All personnel should have a heightened sense of awareness of their surroundings.
• If treating casualties in cold zone, ensure that casualties have been searched prior to patient care and/or transport. This includes unconscious patients.
• If units find themselves in a potentially violent situation they should immediately retreat to a safe location. Emergency traffic and/or EMER buttons should be used if necessary.
203.06A
9/13

Question 59

In a Unified Command, responding agencies (PD, Fire, Utilities, or other city department) blend into an integrated, unified team. A unified approach results in:(read only)

Answer 59

-A shared understanding of priorities and restrictions.
-A single set of incident objectives.
-Collaborative strategies.
-Improved internal and external information flow.
-Less duplication of efforts
-Better resource utilization.
203.06A
9/13

Question 60

Critical Tactical Considerations: Unified Command Established.(read only)

Answer 60

Initial Police and Fire Unified command shall be in place with good communications and jointly located. This needs to be in place as soon as possible. Initial Police and Fire Unified command must agree that there are viable casualties. Initial Police and Fire Unified command must consider the Risk Management Profile and available information and jointly develop or at a minimum jointly approve a rescue plan. The Fire IC will consider the Risk Management Profile and all information available and has the final say as to deployment of fire resources into the warm zone. Accountability shall be in place and tracked throughout the incident. Rescue Task Force members shall be in constant communication with Fire IC or designee.
203.06A
12/13

Question 61

Rescue Task Force briefings shall Include brief face to face communication on the following:(Read only)

Answer 61

*Route into the designated area and team formations.
*Identify security (PD) and FD lead members.
*Communications / Signals.
*How to respond if team comes under fire or an IED is located (PD).
*Casualty removal to Extrication teams.
* Identify threshold between warm and cold zones for patient hand-off to Extrication teams.
*Primary and secondary egress routes (PD).
*Obtain current incident status and threat assessment (PD).
*Determine the approximate count of victim(s)/hostage(s), status (PD).
*Identify zones and perimeters, think cover or concealment (PD). o Understand Objectives (PD and RTF).
*Determine if “shelter in place” or “evacuation” strategy is going to be implemented (PD and RTF).
*Determine location of evacuation corridor (PD, RTF).
• Occupants to be extracted should be quickly checked for weapons prior to treatment and extrication.
• Only immediate lifesaving EMS care should be delivered in the warm zone.
• It is important to minimize exposure time in the warm zone.
• Corridors to the cold zone will be identified in the IAP for the RTF teams.
• RTF teams should only take appropriate equipment into the warm zone
and keep in mind mobility is paramount.
• RTF members shall enter as a team, leave as a team and shall not become separated.
• If RTF is threatened or comes under fire, follow the Law Enforcement leads direction for cover.
• Extrication/RTF Casualty Medical Care: -Tactical Emergency Casualty Care (TECC)
*Lifesaving care to include; hemorrhage control, basic airway management, and rapid extrication to CCP/Treatment area.
*Consider - some form of patient marking during rapid evaluation phase to prevent reevaluation by subsequent crews. (Ribbons, Tags, Etc.)
*Consider - secondary casualty reevaluation when scene and resources allow.
203.06A
12/13

Question 62

Critical Tactical Considerations: Ingress and Egress Established.(read only)

Answer 62

Initial Police and Fire Unified command shall designate and agree to a specific ingress and egress path for Rescue Task Force teams.
203.06A
12/13

Question 63

Critical Tactical Considerations: Casualty Collection Point Established.(read only)

Answer 63

Designate a location for the Casualty Collection Point (CCP).
203.06A
12/13

Question 64

Critical Tactical Considerations: Warm Zone Established.(read only)

Answer 64

The boundaries of the specific warm zone area for entry shall be defined and communicated to the Extrication team(s) and RTF team(s) to ensure personnel do not enter hot zones.
203.06A
12/13

Question 65

Once the decision has been made to deploy members as part of the Rescue Task Force, consider the following:(Read only)

Answer 65

• Initial Police and Fire Unified Command shall be in place with good communications and jointly located as soon as feasible as defined by local jurisdiction.
• Prior to Fire commitment, Initial Police and Fire Unified Command must agree that there are viable casualties.
• Unified Command should consider the amount of resources that may be necessary to safely and efficiently support an Extrication/Rescue Task Force operation prior to committing resources.
• Initial Police and Fire Unified Command shall designate and agree to a specific ingress and egress path for PD, Extrication Teams and Rescue Task Force teams.
• The boundaries of the specific warm zone area for entry shall be defined and communicated to the RTF team. RTF teams do not work in hot zones.
• Initial Police/Fire Unified Command must jointly develop or, at a minimum, jointly approve of a rescue plan based on available information and with considering the Risk Management Profile.
• The Fire IC will consider the Risk Management Profile and all information available and has the final say as to deployment of fire resources into the warm zone.
• Accountability shall be in place and tracked throughout incident.
• Unified Command should consider assigning a unit(s) for Family Support/Occupant Services as deemed appropriate.
203.06A
10/13

Question 66

Physical or mechanical processes implemented to improve efficiency and safety while decreasing exposure risk are known as?

Answer 66

Engineering controls.
Examples include, portable sharps containers, waterless hand cleaner, needleless systems, etc. The EMS Equipment Team, Safety Officer and Infection Control Officer will work together to research, review and test new engineering control products.
203.06B
5/18

Question 67

During major health events such as pandemic influenza outbreaks:

Answer 67

Reusable half face piece APR’s (air purifying respirator) cartridge masks will be issued. The mask comes with two P100 (HEPA) cartridges which can be reused indefinitely when properly decontaminated after each call.
• Prior to doffing mask. Don a fresh pair of gloves and remove mask. Spray the entire exterior surface of the mask and cartridges down with the proper disinfectant solution. Allow to air dry prior placing in protective pouch.
Decontamination solutions shall be selected relative to the type of outbreak.
• H1N1 – Lysol spray and/or wipes
203.06B
13/18

Question 68

Keep Foods at safe temperatures. (read only)

Answer 68

Hold cold foods at 40° F or below.
Keep hot foods at 140° F or above. Foods are no longer safe to eat when they have been in the danger zone of 40° F - 140° F for more than 2 hours (1 hour if the temperature was above 90° F). When shopping, the 2 hour window includes the amount of time food is in the grocery basket, car and on the kitchen counter.
203.06B
15/18

Question 69

Command should rapidly survey the scene to identify any hazards or safety concerns (MMVA) and establish a safe zone for crews to operate. This can be accomplished through:

Answer 69

Proper defensive apparatus positioning, use of flashing lights and the placement of cones, and the use of charged hand-lines.
Additional traffic control should be requested from law enforcement through Alarm.
203.01
4/10

Question 70

Most multiple-patient incidents need(MMVA):(Read only)

Answer 70

Patient triage, extrication, treatment, and transportation.
The purpose of Triage Sector is to determine, in close coordination with Extrication, the location, number and condition of patients and whether triage should be performed before or after patients are extricated from the site.
The purpose of Extrication Sector is to determine, in conjunction with Triage, the location, number and condition of patients and whether triage will be performed before or after patients are extricated from the impact area.
The purpose of Treatment Sector is to first determine whether patient treatment will occur “in place” or in a designated treatment area. Generally, a centralized treatment area is preferred because patient care and site operations are usually enhanced.
The Treatment Sector officer should coordinate patient allocation with Transportation Sector and notify Command when all patients have been treated.
The purpose of Transportation Sector is to obtain all modes of transportation needed to take patients to the hospital(s). Transportation should determine, in conjunction with Command, the location of the staging area, rescue/ambulance loading area, and helicopter landing-zone. Transportation Sector is also responsible for determining hospital availability through Alarm, coordinating patient allocation with Treatment Sector, and supervising the movement of patients from the treatment area to the rescue/ambulance loading area or helicopter landing-zone.
Transportation Sector should also determine hospital destination and notify hospitals of rescue/ambulance arrival (through Alarm). Transportation should also remove patient tracking slips from the triage tag prior to transport, notify Command when all IMMEDIATE patients have been transported (an EMS Tactical benchmark) and maintain an accounting of all patients.
203.01
7/10

Question 71

As the incident (MMVA)escalates, a Staging Sector may be required. To avoid scene congestion, a Level II staging area will be identified for any ____ Alarm Medical incident or greater. At least one company will be assigned to staging.

Answer 71

First.
203.01
8/10

Question 72

Medical Supply Sector is responsible for the procurement, delivery and stockpiling of medical supplies needed at the scene. This sector should be established on ___ Alarm Medical or greater incidents(MMVA).

Answer 72

Third.
Consider using Phoenix’s Medical Support 19 apparatus located at Phoenix Sky Harbor Airport if the need is severe. This unit will have medical supplies, oxygen refill capability and an oxygen distribution system.
203.01
8/10

Question 73

A mass casualty incident may require the implementation of a separate “Medical Branch” and/or “Transportation Branch.” Each would direct all sectors assigned and report to Command.
The Medical Branch Director is responsible for ensuring that the functions of _______, ________, and ________ are carried out.

Answer 73

Triage, extrication and treatment.
203.01
8/10

Question 74

The following items represent the standard operations that will normally be performed by the Triage Sector officer:(Read only)

Answer 74

1. Determine the location, number and condition of patients.
2. Determine, in close coordination with Extrication Sector, if triage will be performed in place or at the entrance to the treatment area.
3. Determine resources.
4. Assign and supervise triage teams.
5. Ensure that patient triage is based on S.T.A.R.T., that life-saving emergency medical care is provided as needed, and that patients are accounted for and tagged appropriately.
6. Ensure safety and accountability of all assigned members.
7. Provide frequent progress reports to Command.
8. Coordinate activities with other sectors.
9. When triage is complete, provide Command with a “TriageReport.”
10. Forward triage tracking slips to Command.
11. Terminate triage activities and inform Command that members are available for reassignment.

The Triage Sector Officer should wear a sector vest for identification purposes. At smaller incidents, up to 10 patients, triage may be handled by the first arriving company officer and his/her crew. At larger incidents, more than 10 patients, the first arriving company officer should assume Command and assign Triage to the next arriving fire company.
203.02
2/3

Question 75

The following items represent the standard operations that will normally be performed by the Treatment Sector Officer:(Read only)

Answer 75

1. Identify whether patient treatment will occur “in place” or in a designated treatment area. Coordinate with Triage and Extrication Sector Officers.
2. Determine resources.
3. Identify and establish a large treatment area. If incident is large, establish separate “IMMEDIATE” and “DELAYED” treatment areas.
4. Assign and supervise treatment teams.
5. Ensure that all patients have been triaged, assessed and re-triaged as needed.
6. Aggressive treatment and rapid packaging of patients.
7. Provide frequent progress report to Command.
8. Ensure safety and accountability of all patients and assigned members.
9. Verify transportation priorities with Transportation Sector.
10. Coordinate with other sectors.
    11.Notify Command when all patients have been moved from the treatment area.
    203.04
    2/5

Question 76

If treatment will occur “in place,” companies should be directed by the Treatment Sector Officer to specific patient or vehicle (e.g., “E210, you have the patients in the red sedan. L209 will assist.”). The goal will be to assign ___ ALS or BLS company and ___ ambulance to each patient, resources permitting.

Answer 76

One.
203.04
2/5

Question 77

The officer of the first-arriving unit(MCI Response )will establish Command and:(Read only)

Answer 77

• Perform a size-up, estimating the number of victims.
• In all MCI scenarios the focus needs to be on the rapid triage and transportation of all immediate patients.
• Request appropriate alarm level.
“Engine 202 is on the scene we have a six car MVA heavy damage one care on fire, and extrication needed, balance to a second Alarm Medical, have all enter off Mesa Drive and have units come directly to the scene.”
• Identify a staging area.
“Have units stage in the west parking lot of the mall.”
• If it is an active shooter incident (SOP 203.06A) or any tactical environment with a MCI, establish a Unified Command (UC) with Law Enforcement (LE).
The First Command Officer will establish Liaison for FD and LE, the Liaisons can interact with LE command allowing the transfer of info between agencies.
Law Enforcement will make entry with their Contact Team and provide feedback to the UC and the decision may be made to establish a Rescue Task Force Team. The Rescue Task Force Team will initiate triage and provide immediate lifesaving treatment (i.e. hemorrhage control) and rapid extrication to the cold zone if safe to do so.
• If the area is deemed safe to enter direct the remaining crew members and any additional personnel arriving to initiate triage.
• Triage will be performed in accordance with START or Jump START.
• Prioritize victims utilizing color-coded ribbons or placards:
*Red-Immediate care
*Yellow-Delayed care
*Green-Ambulatory (minor)
*Black-Deceased (non salvageable)
• Locate and direct the “walking wounded” to one location away from the incident Immediate treatment area to a Delayed patient treatment area, if possible. These victims need to be assessed as soon as possible. Assign someone to keep the walking wounded together.
• Active shooter incident considerations: Be on high alert for suspicious individuals, packages, vehicles or potential IEDs. Integrated active shooter response should include the critical actions contained in the acronym THREAT:
-Threat suppression
-Hemorrhage control
-Rapid-Extrication to safety
-Assessment by medical providers
-Transport to definitive care
203.06
3/7

Question 78

What are the Command responsibilities in a MCI event:

Read only

Answer 78

1. First arriving officer will establish “Command.”
2. If criminal or active shooter or tactical environment incident use direction from SOP 203-06A get briefing from LE, establish a Unified Command and co-locate with LE.
3. Remain in a safe, fixed, and visible location, uphill and up wind of the incident.
4. Determine the MCI Alarm response Level (1,2,3,4, or 5). If unknown victims in an active shooter/tactical environment initiate an MCI Alarm level 1 until a count can be determined.
5. Designate a staging area.
6. Assign Sector Officers to fulfill the functions of Collection Point Triage, establishing Rescue Task Force, Treatment, Transportation, and Staging.
7. Advise Mesa Alarm of the number of victims and their categories once triage is complete.
8. During large-scale or complex MCIs (e.g., a fire with multiple victims/tactical environment incident), designate a Medical Branch to reduce the span of
   control.
9. If the incident is due to a known or suspected weapon of mass destruction (WMD event), upgrade to first alarm or greater HazMat, set up Decontamination area and ALS units to assist with decontamination, antidotes, and treatment of victims. Request on call TLO.
   10.Request Chempak deployment if situation warrants.
   11.Ensure proper security of the incident site, treatment area, and loading area; also provide for traffic control and access for emergency vehicles, including law enforcement.
   203.06
   5/6

Question 79

Each unit should carry an MCI bag. The following items are recommended:(Read only)

Answer 79

*Two (2) triage packs recommended to have: -Gloves
-One (1) pediatric face mask
-Colored ribbons either rolls or ribbons (Red, Yellow, Green & Black) or Stickers style placards red and black.
-Trauma Tourniquets (2)
-Hemostatic Dressing (2)
-Chest Seals (2)
-Fifty (50) triage tags—Disaster Management Systems (DMS) All Risk Triage tags.
-Pencils/grease pencils and pens.
203.06
6/6

Question 80

Specific items, information or tasks that have been identified for consideration as part of the progression in dealing with an active shooting incident.

Answer 80

Critical Tactical considerations.
203.06A
3/13

Question 81

A group of law enforcement personnel dedicated to, and responsible for, the safety and security of fire personnel working in a warm or cold zone. Must be included as part of Rescue Task Force.

Answer 81

Force Protection.
203.06A
3/13

Question 82

Responsible for the management of Extrication Teams & Rescue Task Force under the unified command model.

Answer 82

Rescue Sector.
The Rescue sector officer may operate at the threshold of the warm zone.
203.06A
4/13

Question 83

Law Enforcement has determined that there are no known threats in the immediate area or incident location, and it is safe to move about the perimeter.

Answer 83

Scene safe to enter.
203.06A
4/13

Question 84

Units should stage far enough away as to not become part of the incident, out of line of sight, out of line of fire, behind cover and with two directions of egress without turning around. Companies should turn off warning lights and be aware of any crowds that may pose a hazard.

Answer 84

Stage for L.E.
203.06A
4/13

Question 85

The suspect(s) have stopped moving and appear to be contained.

Answer 85

Static Situation.
An uncontained static suspect(s) can become dynamic without notice.
203.06A
5/16

Question 86

No significant danger/threat anticipated. Location of command post, treatment/staging areas.(ASHE)

Answer 86

(ASHE)Cold zone.
203.06A
5/13

Question 87

The components of the Mesa Fire Department Infection Control Program include:(Read only)

Answer 87

• The Infection Control Plan
The Infection Control Plan broadly establishes the need, management of, and policy statement for the program. A copy of the plan is on file at the EMS Office and on the MFMD EMS and Personnel and Wellness home pages. This document will be revised annually, or when necessary to meet OSHA rule changes.

• Risk management assessment
Exposure risk, defined as the assessment of the potential risk of an infectious exposure, is determined by job classification and duties. All Department positions are assigned one of three risk classifications.
• Those jobs with an increased risk of an occupational exposure such as Emergency Medical Technicians and Paramedics.
• Those jobs with some risk of an occupational exposure such as Battalion Chiefs (Supervisors), Support Services Personnel (Medical Equipment Repair), Recruit Firefighters, Pre-Recruits (medical equipment transport and/or cleaning), Connectors/Volunteers (people and medical equipment transport).
• Those with minimal or no risk of an occupational exposure such as administrative positions, clerical staff, and support staff.
Risk assessment will be performed when new positions are created or when duties of existing positions change.

• Training, work practices and engineering controls
All employees who have occupational exposure to bloodborne pathogens will receive initial and annual training on the epidemiology, symptoms, and transmission of bloodborne pathogen diseases, to be conducted by the MFMD EMS Division. The training program can be found in the MFMD Exposure Control Plan and contains the following:
• A copy and explanation of the OSHA bloodborne pathogen standard
• A general explanation of the epidemiology and symptoms of bloodborne diseases
• An explanation of the modes of transmission of bloodborne pathogens
• An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment
• An explanation of MFMD’s exposure control plan and the means by which the employee can obtain a copy of the written plan
• An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials
• An explanation of the use and limitations of engineering controls, work practices, and PPE
• Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment
• An explanation of the basis for PPE selection
• Information on the Hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine will be offered free of charge
• Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials
• An explanation of the procedures to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available
• Information on the post-exposure evaluation and follow-up that MFMD is required to provide for the employee following an exposure incident
• An explanation of the signs and labels and/or color coding required by the standard
Training records shall include the following information:
• The dates of the training sessions
• The contents or a summary of the training sessions
• The names and qualifications of persons conducting the training
• The names and job titles of all persons attending the training sessions
Training records shall be maintained for 3 years from the date on which the training occurred.
Annual infection control training shall be provided to all members who are at an increased risk or have some risk of exposure. Those considered at minimal or no risk will be offered training opportunities.
Training will be conducted using a variety of methods including, but not limited to, classroom, self-study, internet-based and teleconferencing. Topics will include bloodborne diseases, principles of disease transmission, proper use of PPE, work practices, use of engineering controls, bio-hazard waste disposal, housekeeping practices, personal and equipment disinfecting, and post exposure procedures. EMS Office is responsible for tracking training completion.

Engineering and work practice controls shall be used to eliminate or minimize employee exposure, including:
• Asking patients to turn their head away and cover their mouth/nose when coughing or sneezing
• Minimizing the number of treatment personnel to possible exposure.
• Avoiding direct contact with body fluids
• NOT wiping eyes, nose, or mouth before washing hands.
• Washing any affected body part immediately, if contaminated with body fluids.
• Using appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water as soon as feasible.
• Placing contaminated waste and equipment into red bio-hazard bags and disposing of, as required by this plan.
• Using sharps containers that are puncture resistant; labeled or color- coded; and leak-proof on the sides and bottom. Sharp disposal containers are available in each fire station.
• Broken glassware that may be contaminated is only picked up using mechanical means, such as a brush and dustpan.
• Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.
• All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.
• Health and fitness maintenance programs
• Exposure management procedures
• Infection Control Officer responsibilities and duties
203.06B
2-7/18

Question 88

Members shall use the infection control (IC) personal protective equipment (PPE), distributed by the Department, to protect against exposures. The IC PPE pack will include the following items:

Answer 88

• Re-usable protective eyewear/glasses
• Disposable droplet (N95) face mask
• Disposable sleeves
• Disposable gown
• Disposable gloves
• Anti-microbial skin cleaner
• Disposable CPR barrier device
• Portable sharps container
C-Shift company officers assigned to a station will ensure that all necessary personal protective equipment, engineering controls (e.g., sharps containers), labels, bio-hazard bags, etc. are maintained in adequate supplies with appropriate sizes at their stations by way of monthly medical supply requests through Fire Resource and Southwest Ambulance.
The following PPE shall be used on ALL patients, regardless of engineering and work practice controls:
• Non-latex medical examination gloves (contaminated torn, punctured, or compromised gloves shall be replaced immediately or as soon as possible).
*Gloves should be used when healthcare workers have contact with blood or other body fluids.
*Gloves should be removed after caring for a patient.
*The same pair of gloves should not be worn for the care of more than one patient.
*Gloves should never be washed or reused.
• Protective eyewear (side shields, LED lighting and near-vision correction available)
The following PPE shall be immediately available for use, in addition, but not in place of gloves and eyewear:
• HEPA or N95 masks
• Trauma sleeves
• Gowns
• Face shields
• Shoe covers or boots (where gross contamination can be anticipated)
203.06B
7-9/18

Question 89

Handling Infectious/Non-Infectious Materials

The surface to be cleaned should be left wet with the disinfectant for 30 seconds for ___ and for 10 minutes for ___.

Answer 89

HIV-1 and HBV(Hepatitis B Virus)
203.06B
10/18

Question 90

All members are personally responsible for their health and fitness. The Department will provide medical exams and fitness evaluations. Members will decrease their risk of acquiring an infectious disease by maintaining high health and fitness levels. Therefore, members:

Answer 90

Maintain Health & Fitness Levels
• Should take advantage of immunizations, vaccinations and tests offered by the Department.
• Shall comply with required annual health exams and take action to follow up on problems identified.
• Shall comply with required annual fitness evaluations and take action to correct weaknesses identified.

Personal Hygiene
• Shall practice good general hygiene on and off-duty.
• Shall hand wash with anti-microbial soap and water when hands are visibly dirty, contaminated, or soiled.
• Use alcohol based hand rub when hands are not visibly soiled
• Clean uniforms when soiled by patient body fluids.

Decontamination Procedure
1. Begin with soap and hot water
2. Next, use a 1:10 bleach/water solution or EPA approved germicide.
3. The surface to be cleaned should be left wet with the disinfectant for 30
seconds for HIV-1 and for 10 minutes for HBV
4. Rinse item thoroughly.
5. Allow to air dry before storing.

Equipment that cannot be submerged (stethoscope, ECG leads, monitor, etc.) should be cleaned using a spray bottle and disposable towel.
203.06B
12/18

Question 91

The Mesa Fire and Medical Infection Control Program is the responsibility of the ___ _______.

Answer 91

EMS Office.
EMS Coordinators are the designated Infection Control Officers (ICO). When the ICO’s are absent or cannot be contacted, program administrative responsibilities and infectious exposure management duties will be transferred to the Battalion Safety Officers, or any other trained shift-level infection control officer.

Description of Duties
The MFMD Infection Control Officer identifies the need for changes in engineering controls and work practices through review of OSHA records, employee interviews, committee activities, and direction received through our Medical Control. An EMS Infection Control Team, consisting of both front-line workers and management officials are involved in this.
The EMS Division’s Infection Control Officer (ICO) will ensure that all medical actions required are performed and that appropriate employee health and OSHA records are maintained, including:
• Monitoring any changes in technology that eliminate or reduce exposure to bloodborne pathogens
• Annually documenting consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure;
• Reviewing and updating the ECP annually or more frequently if necessary to reflect any new or modified tasks and procedures that affect occupational exposure and to reflect new or revised employee positions with occupational exposure;
• Training, documentation of training, and making the written ECP available to employees, OSHA and NIOSH representatives.
• Ensuring that the recommendations of the Infection Control Committee are implemented.

The ICO is responsible for:
• The annual review of the Department’s Infection Control Plan.
• Investigating all reports of infectious exposures.
• Providing guidance and follow-up instructions when an infectious exposure occurs.
• Liaison communications with hospital infection control personnel.
• Requesting source patient testing.
• Maintaining strict confidentiality of infectious exposure.
• Coordinating the collection and security of all infectious exposure records.
• Coordinating the immunization and vaccination of personnel.
EMS office will be responsible for assuring that the ICO position is assigned 24 hours a day. The ICO will be available to all personnel for immediate direction on infection control issues. In the event of an exposure, the ICO will provide timely and accurate direction on follow-up procedures.
203.06B
16-18/18